The Annals of thoracic surgery · 2020
Long-term Results and Functional Outcomes After Surgical Repair of Benign Laryngotracheal Stenosis.
СтатьяНазвание и аннотация: Перевод в очереди
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Nauta Anapa, Mitilian Delphine, Hanna Amir, Mercier Olaf, Crutu Adrian, Fabre Dominique, Fadel Elie
Аннотация
BACKGROUND: Laryngotracheal resection and anastomosis (LTRA) is a reliable treatment for benign subglottic laryngotracheal stenosis (BSLTS), but data on functional outcomes are scarce. We assessed the surgical and functional outcomes of LTRA in BSLTS.
METHODS: We retrospectively reviewed consecutive patients who underwent LTRA for BSLTS in 2007 to 2018. The 30-day outcomes were mortality, complications, and success rate. At the last follow-up, patients completed functional questionnaires (visual analog scale [VAS] and modified Medical Research Council scale for dyspnea, a VAS for swallowing, and the Voice Handicap Index) and assessed quality of life.
RESULTS: Of 43 patients with BSLTS, 28 underwent the modified Pearson technique, and 15 Grillo's procedure. During the first 30 days, no patients died, the postoperative complication rate was 44%, and the success rate was 95%. After a mean follow-up of 53 months in 38 patients (88%), 7 patients had restenosis and 36 had late surgical success (95%). In the 34 patients who completed the questionnaires (79%), mean VAS dyspnea scores decreased significantly during rest (-5.4 ± 4.2) and exercise (-5.6 ± 4.4) (P < .001). A trend toward a decrease in modified Medical Research Council scale was found (P = .057; grade 0 in 62% of patients). The Voice Handicap Index indicated that voice impairment was absent to moderate in 30 patients (88%) and severe in 4 (12%). The VAS dysphagia scores were not significantly different before and after surgery. Quality of life gains were reported by 85% of patients.
CONCLUSIONS: Laryngotracheal resection and anastomosis for BSLTS is safe and provides excellent surgical and functional outcomes with an improved quality of life. Laryngotracheal resection and anastomosis is a valid treatment option for BSLTS.
METHODS: We retrospectively reviewed consecutive patients who underwent LTRA for BSLTS in 2007 to 2018. The 30-day outcomes were mortality, complications, and success rate. At the last follow-up, patients completed functional questionnaires (visual analog scale [VAS] and modified Medical Research Council scale for dyspnea, a VAS for swallowing, and the Voice Handicap Index) and assessed quality of life.
RESULTS: Of 43 patients with BSLTS, 28 underwent the modified Pearson technique, and 15 Grillo's procedure. During the first 30 days, no patients died, the postoperative complication rate was 44%, and the success rate was 95%. After a mean follow-up of 53 months in 38 patients (88%), 7 patients had restenosis and 36 had late surgical success (95%). In the 34 patients who completed the questionnaires (79%), mean VAS dyspnea scores decreased significantly during rest (-5.4 ± 4.2) and exercise (-5.6 ± 4.4) (P < .001). A trend toward a decrease in modified Medical Research Council scale was found (P = .057; grade 0 in 62% of patients). The Voice Handicap Index indicated that voice impairment was absent to moderate in 30 patients (88%) and severe in 4 (12%). The VAS dysphagia scores were not significantly different before and after surgery. Quality of life gains were reported by 85% of patients.
CONCLUSIONS: Laryngotracheal resection and anastomosis for BSLTS is safe and provides excellent surgical and functional outcomes with an improved quality of life. Laryngotracheal resection and anastomosis is a valid treatment option for BSLTS.